Fontan conversion with arrhythmia surgery

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Kim, Woong-Han; Lim, Hong Gook; Lee, Jeong Ryul; Rho, Joon Ryang; Bae, Eun Jung; Noh, Chung Il; Yoon, Yong Soo; Kim, Yong Jin
Issue Date
Eur J Cardiothorac Surg. 2005 Feb;27(2):250-7.
AdolescentAdultArrhythmias, Cardiac/etiology/mortality/*surgeryAtrial Flutter/etiology/mortality/surgeryChildChild, PreschoolFemaleFontan Procedure/*methodsHeart Atria/physiopathologyHeart Defects, Congenital/complications/mortality/*surgeryHumansMalePacemaker, ArtificialPostoperative Complications/etiologyProtein-Losing Enteropathies/complications/surgeryPulmonary Embolism/complications/surgeryReoperationTreatment Outcome
OBJECTIVE: Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We reviewed our experience with Fontan conversion and concomitant arrhythmia surgery. METHODS: Between January 1996 and February 2004, 16 patients underwent Fontan conversion and arrhythmia surgery. Mean age at the initial Fontan operation was 5.1+/-3.5 (range: 2-15) years and mean age at Fontan conversion was 17.0+/-5.8 (range: 6-30). The initial Fontan operations were atriopulmonary connections in 14 patients, extracardiac lateral tunnel in 1, and intracardiac lateral tunnel in 1. The types of arrhythmia included atrial flutter in 10 patients and atrial fibrillation in 3. Fontan conversion operation was performed with intracardiac lateral tunnel in 5 patients and extracardiac conduit in 11. Arrhythmia surgery included isthmus cryoablation in 10 patients and right-sided maze in 3. RESULTS: There has been no mortality. At Fontan conversion operation, 7 patients required permanent pacemaker. All patients have improved to New York Heart Association class I or II. With a mean follow-up of 26.9+/-30.6 (range:1-87) months, 16 patients had sinus rhythm, 2 patients had transient atrial flutter which was well controlled, and 2 patients required permanent pacemaker during follow-up. CONCLUSIONS: Fontan conversion with concomitant arrhythmia surgery and permanent pacemaker placement is safe, improves New York Heart Association functional class, and has a low incidence of recurrent arrhythmias. In most patients, concomitant permanent pacemakers are needed.
1010-7940 (Print)
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College of Medicine/School of Medicine (의과대학/대학원)Thoracic Surgery (흉부외과학전공)Journal Papers (저널논문_흉부외과학전공)
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